<#include "/client/config.ftl"/>
<!DOCTYPE html>
<html>
	<head>
		<meta charset="UTF-8">
		<meta name="viewport" content="width=device-width, initial-scale=1,maximum-scale=1, user-scalable=no">
		<title>用户注册</title>
		<link rel="stylesheet" href="${base}/css/bootstrap.min.css" />
		<script type="text/javascript" src="${base}/js/jquery-1.12.0.min.js"></script>
		<link rel="stylesheet" href="${base}/css/common.css" />
		<script type="text/javascript" src="${base}/js/common.js" ></script>
	</head>
	<body>
		<div class="container-fluid">
			<form action="${base}/client/user/register" method="post">
				<div class="form-group mar_top">
					<label class="login_reg_label">姓名：</label>
					<input type="text" placeholder="请输入姓名" name="name" class="form-control login_reg_input"/>
				</div>
				<div class="form-group">
					<label class="login_reg_label">性别：</label>
					<select name="sex" class="form-control login_reg_input">
						<option value="男">男</option>
						<option value="女">女</option>
					</select>
				</div>
				<div class="form-group">
					<label class="login_reg_label">年龄：</label>
					<input type="number" class="form-control login_reg_input" placeholder="请输入年龄" name="age" />
				</div>
				<div class="form-group">
					<label class="login_reg_label">手机号码：</label>
					<input type="number" class="form-control login_reg_input" placeholder="请输入手机号码" name="phone" />
				</div>
				<div class="form-group">
					<label class="login_reg_label">微信号：</label>
					<input type="text" class="form-control login_reg_input" placeholder="请输入微信号" name="weichat" />
				</div>
				<div class="form-group">
					<label class="login_reg_label">家属号码：</label>
					<input type="number" class="form-control login_reg_input" placeholder="请输入家属号码" name="fphone" />
				</div>
				<div class="form-group">
					<label class="login_reg_label">诊断结果：</label>
					<input type="text" class="form-control login_reg_input" placeholder="请输入诊断结果" name="diagnosis" />
				</div>
				<div class="form-group">
					<label class="login_reg_label">受教育成度：</label>
					<select name="edu" class="form-control login_reg_input">
						<option value="小学">小学</option>
						<option value="初中">初中</option>
						<option value="高中及大专">高中及大专</option>
						<option value="本科以上">本科以上</option>
					</select>
				</div>
				<div class="form-group">
					<label class="login_reg_label">是否有医学背景：</label>
					<select name="medicbg" class="form-control login_reg_input">
						<option value="是">是</option>
						<option value="否">否</option>
					</select>
				</div>
				<div class="form-group">
					<label class="login_reg_label">经济状况：</label>
					<select name="economy" class="form-control login_reg_input">
						<option value="全自费">全自费</option>
						<option value="农村合作医疗">农村合作医疗</option>
						<option value="社会医疗保险">社会医疗保险</option>
						<option value="公费医疗">公费医疗</option>
						<option value="其他">其他</option>
					</select>
				</div>
				<div class="hidden_area">
					<input type="hidden" name="openid" value="openid" />
				</div>
				<div class="form-group login_reg_btn">
					<button type="submit"  class="btn btn-primary">注册</button>
				</div>
			</form>
		</div>
	</body>
</html>
